Provider Demographics
NPI:1235469958
Name:FAMILY FOOT CARE PC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:NEYLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-447-8990
Mailing Address - Street 1:171 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1849
Mailing Address - Country:US
Mailing Address - Phone:201-447-8990
Mailing Address - Fax:201-447-4298
Practice Address - Street 1:171 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1849
Practice Address - Country:US
Practice Address - Phone:201-447-8990
Practice Address - Fax:201-447-4298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00141100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1828100Medicaid
NJ1828100Medicaid